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Leukopenia predicts remission in patients with inflammatory bowel disease and Behcet's disease on thiopurine maintenance.

Authors
 Mi Sung Park  ;  Dong Hyun Kim  ;  Duk Hwan Kim  ;  Soo Jung Park  ;  Sung Pil Hong  ;  Tae Il Kim  ;  Won Ho Kim  ;  Jae Hee Cheon 
Citation
 DIGESTIVE DISEASES AND SCIENCES, Vol.60(1) : 195-204, 2015 
Journal Title
 DIGESTIVE DISEASES AND SCIENCES 
ISSN
 0163-2116 
Issue Date
2015
MeSH
Adolescent ; Adult ; Aged ; Azathioprine/adverse effects ; Azathioprine/therapeutic use* ; Behcet Syndrome/drug therapy* ; Behcet Syndrome/epidemiology* ; Colitis, Ulcerative/epidemiology* ; Comorbidity ; Crohn Disease/epidemiology* ; Female ; Humans ; Immunosuppressive Agents/adverse effects ; Immunosuppressive Agents/therapeutic use* ; Kaplan-Meier Estimate ; Leukopenia/chemically induced ; Leukopenia/epidemiology* ; Male ; Mercaptopurine/adverse effects ; Mercaptopurine/therapeutic use* ; Middle Aged ; Multivariate Analysis ; Prognosis ; Remission Induction ; Retrospective Studies ; Young Adult
Keywords
Thiopurine ; Leukopenia ; Inflammatory bowel disease ; Remission ; Relapse
Abstract
BACKGROUNDS: The thiopurine drugs, azathioprine (AZA), and 6-mercaptopurine (6-MP) are well-established drugs for the treatment of inflammatory bowel disease (IBD). Although leukopenia is a well-recognized side effect of AZA/6-MP treatment, its association with therapeutic effects has yet to be determined. We therefore evaluated the influences of thiopurine-induced leukopenia on the long-term prognosis of IBD. METHODS: We included 196 IBD patients [45 with ulcerative colitis (UC), 68 with Crohn's disease (CD), and 83 with intestinal Behçet's disease (BD)] who were treated with AZA/6-MP and achieved remission between January 2006 and December 2012. We retrospectively analyzed patient characteristics, AZA/6-MP maintenance dose (mg/kg), the lowest white blood cell (WBC) count during AZA/6-MP treatment, duration of remission, and the occurrence of relapse. We compared the clinical variables between leukopenic (n = 120, WBC count <4,000/μL) and nonleukopenic (n = 76, WBC count ≥ 4,000/μL) patients. RESULTS: The two groups were well matched for baseline clinical characteristics. The cumulative relapse-free survival rate was higher in the leukopenic group than the nonleukopenic group by Kaplan-Meier survival analysis (log-rank test, P < 0.001). On multivariate analysis, age, duration of AZA/6-MP treatment, presence of macrocytosis, and the presence of leukopenia were negatively associated with relapse (odds ratios 0.975, 0.988, 0.563, and 0.390, respectively). On subgroup analysis, the cumulative relapse-free survival rate was significantly higher in the leukopenic group than in the nonleukopenic group for all types of IBDs, including UC, CD, and intestinal BD (log-rank test, P = 0.032, 0.047, and 0.002, respectively). CONCLUSION: Leukopenia during thiopurine maintenance therapy was associated with prolonged remission in patients with IBD and Behcet's disease.
Full Text
http://link.springer.com/article/10.1007%2Fs10620-014-3355-4
DOI
10.1007/s10620-014-3355-4
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Duk Hwan(김덕환)
Kim, Dong Hyun(김동현)
Kim, Won Ho(김원호) ORCID logo https://orcid.org/0000-0002-5682-9972
Kim, Tae Il(김태일) ORCID logo https://orcid.org/0000-0003-4807-890X
Park, Mi Sung(박미성)
Park, Soo Jung(박수정)
Cheon, Jae Hee(천재희) ORCID logo https://orcid.org/0000-0002-2282-8904
Hong, Sung Pil(홍성필)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139292
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